Modelling the dynamic effects of elective hospital admissions on emergency levels in England
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Modelling the dynamic effects of elective hospital admissions on emergency levels in England Sergi Jimenez-Martin1,2,3 · Catia Nicodemo4,5,6
· Stuart Redding4,5
Received: 6 January 2018 / Accepted: 27 March 2019 © The Author(s) 2019
Abstract In England as elsewhere, policy makers are trying to reduce the pressure on costs due to rising hospital admissions by encouraging GPs to refer fewer patients to hospital specialists. This could have an impact on elective treatment levels, particularly procedures for conditions which are not life-threatening and can be delayed or perhaps withheld entirely. This study attempts to determine whether cost savings in one area of publicly funded health care may lead to the increases in cost in another and therefore have unintended consequences by offsetting the cost-saving benefits anticipated by policy makers. Using administrative data from Hospital Episode Statistics in England, we estimate dynamic fixed effects panel data models for emergency admissions at Primary Care Trust and Hospital Trust levels for the years 2004–2013, controlling for a group of area-specific characteristics and other secondary care variables. We find a negative link between current levels of elective care and future levels of emergency treatment. This observation comes from a time of growing admissions, and there is no guarantee that the link between emergency and elective activity will persist if policy is effective in reducing levels of elective treatment, but our results suggest that the costsaving benefits to the NHS from reducing elective treatment are reduced by between 5.6 and 15.5% in aggregate as a consequence of increased emergency activity. Keywords I10 · I11 · C01
Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR Health Services and Delivery Research, NIHR, NHS or the Department of Health.
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Catia Nicodemo [email protected]
Extended author information available on the last page of the article
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S. Jimenez-Martin et al.
1 Introduction Successive Labour Governments funded exceptional growth in UK health spending at an average of 6.4% per annum between 1996/1997 and 2009/2010 and while growth has slowed in more recent years (IFS 2015), publicly funded health-care spending in England has, on the whole, been protected from recent austerity measures that have affected most Government departments. However, the National Health Service (NHS) is expected to improve efficiency and to avoid over-spending, as the NHS planning document “Everyone Counts: Planning for Patients 2013/2014” explains. This includes pressure on spending in hospitals, and incentives to encourage GPs to refer fewer patients for specialist hospital care, both of which could impact on elective treatment levels, as procedures can be delayed or perhaps withheld entirely. Our concern is that restricting elective care could lead to an increase in emergency activity as patients seek withheld treatment in other settings. In particular, this study
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